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01.12.2014 | Ausgabe 12/2014

Surgical Endoscopy 12/2014

Minimally invasive colorectal resection is associated with significantly elevated levels of plasma matrix metalloproteinase 3 (MMP-3) during the first month after surgery which may promote the growth of residual metastases

Zeitschrift:
Surgical Endoscopy > Ausgabe 12/2014
Autoren:
H. M. C. Shantha Kumara, David J. Gaita, Hiromichi Miyagaki, Xiaohong Yan, Sonali A. C. Herath, Vesna Cekic, Richard L. Whelan
Wichtige Hinweise
Presented at the Society of American Gastrointestinal and Endoscopic Surgery (SAGES); SS10 scientific sessions April 2–5, 2014 at the Salt Lake Convention Center in Salt Lake City, UT USA.

Abstract

Introduction

MMP-3, a member of the matrix metalloproteinase (MMP) family, is involved in the breakdown of the extracellular matrix in tissue remodeling and may also play a role in cancer progression and metastasis. Minimally invasive colorectal resection (MICR) may increase plasma MMP-3 levels directly via surgical trauma or indirectly due to surgery-associated elevations in TNF-α and IL1 which are regulators of MMP-3. This study’s purpose was to evaluate plasma MMP-3 levels during the first month after MICR for colorectal cancer.

Methods

Patients enrolled in an IRB approved data/plasma bank who underwent elective MICR for CRC. Blood plasma samples had been collected preoperatively, on postoperative day (POD) 1, 3 and at varying postoperative time points and were stored at −80 °C. The late samples (POD 7–41) were bundled into 7 day time blocks and considered as single time points. MMP-3 levels were analyzed in duplicate via ELISA and the results reported as mean ± SD. The paired t test was used for analysis (significance, p < 0.008 after Bonferroni’s correction).

Results

A total of 73 CRC patients who underwent MICR met the inclusion criteria. The mean PreOp MMP-3 level was 14.9 ± 7.8 ng/ml (n = 73). Significantly elevated mean plasma levels were noted on POD 1 (21.4 ± 14.7 ng/ml, n = 73, p < 0.0001), POD 3 (37.9 ± 21.5 ng/ml, n = 72, p < 0.0001), POD 7–13 (22.0 ± 13.0 ng/ml, n = 56, p < 0.0001), POD 14–20 (21.9 ± 10.3 ng/ml, n = 20, p = 0.003), and on POD 21–27 (21.9 ± 11.43 ng/ml, n = 20, p = 0.002) when compared to PreOp levels. Plasma levels returned to the PreOp baseline at the POD 28–41 time point (n = 16, p = 0.07).

Conclusion

Plasma MMP-3 levels remained significantly elevated from baseline for 4 weeks after MICR for CRC. The early postoperative increase in MMP-3 levels may be due to the surgery-related acute inflammatory response; the elevation noted during weeks 2–3 may be related to wound healing. Increased MMP-3 levels may promote metastases or the growth of residual cancer.

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